Measuring the use of this guidance

Recommendation: 1.1.1.3

One of the primary symptoms of COPD is breathlessness. The Medical Research Council (MRC) dyspnoea scale (see table 1) should be used to grade the breathlessness according to the level of exertion required to elicit it.

What was measured: The proportion of people on COPD registers in Wales that have a MRC breathlessness score recorded.

Data collection end: March 2015

88.9%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.1.2.2

Measure post-bronchodilator spirometry to confirm the diagnosis of COPD.

What was measured: Proportion of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to the register.

What was measured: The proportion of people on the COPD register in Wales that have an electronic record of the postbronchodilator FEV1/FVC ratio.

Data collection end: March 2015

19.7%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

What was measured: COPD002: The percentage of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to the register.

Data collection end: March 2016

81%

Data collection end: March 2017

81%

Area covered:

National

Source:

Health and Social Care Information Centre. Quality and Outcomes Framework.

Recommendation: 1.1.3.1

At the time of their initial diagnostic evaluation in addition to spirometry all patients should have:
a chest radiograph to exclude other pathologies
a full blood count to identify anaemia or polycythaemia
body mass index (BMI) calculated.

What was measured: The proportion of people on COPD registers in Wales that have a record of chest X-ray around the
time of diagnosis.

Data collection end: March 2015

63.2%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.2.1.2

All COPD patents still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity

What was measured: The proportion of people who were current tobacco smokers who had been referred for smoking cessation in the last year.

Data collection end: March 2015

74.3%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.2.1.3

Unless contraindicated, offer NRT, varenicline or bupropion, as appropriate, to people who are planning to stop smoking combined with an appropriate support programme to optimise smoking quit rates for people with COPD.

What was measured: The proportion of people with COPD who were current tobacco smokers and received pharmacology for tobacco dependency in the last year.

Data collection end: March 2015

10.8%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.2.2.6

In people with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as required, offer the following as maintenance therapy:
if FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or LAMA
if FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA.

What was measured: The proportion of people with COPD who do not have an asthma diagnosis and who received inhaled corticosteroids (ICS) in the last 6 months of the audit also appropriately received an long-acting beta2 agonists (LABA).

Data collection end: March 2015

92.8%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.2.2.8

Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS, irrespective of their FEV1.

What was measured: The proportion of people with COPD and an MRC breathlessness score of 4 who have received inhaled steroids, long-acting muscarinic antagonist (LAMA) and LABA (triple therapy) in the last 6 months.

Data collection end: March 2015

58%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.2.2.14

Patients should have their ability to use an inhaler device regularly assessed by a competent healthcare professional and, if necessary, should be re-taught the correct technique.

What was measured: The proportion of people who have COPD and are using inhaler therapy received an inhaler technique check.

Data collection end: March 2015

91.3%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.2.8.1

Pulmonary rehabilitation should be made available to all appropriate people with COPD (see 1.2.8.2) including those who have had a recent hospitalisation for an acute exacerbation. [new 2010]

What was measured: Proportion of units with a pulmonary rehabilitation service available to patients discharged after exacerbation.

Data collection end: May 2014

92%

Number that met the criteria: 183 / 198

Data collection end: June 2017

94%

Number that met the criteria: 178 / 190

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: secondary care

What was measured: Proportion of units with a pulmonary rehabilitation service, available to patients who had an exacerbation, where it was available within 4 weeks of discharge.

Data collection end: May 2014

38%

Number that met the criteria: 70 / 183

Data collection end: June 2017

45%

Number that met the criteria: 80 / 178

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: secondary care

What was measured: Proportion of pulmonary rehabilitation programmes that offer pulmonary rehabilitation following hospitalisation for exacerbation of COPD.

Data collection end: April 2015

68%

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

Recommendation: 1.2.8.2

Pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC grade 3 and above). Pulmonary rehabilitation is not suitable for patients who are unable to walk, have unstable angina or who have had a recent myocardial infarction. [2004]

What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 3.

Data collection end: April 2015

96%

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 4.

Data collection end: April 2015

97%

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 5.

Data collection end: April 2015

81%

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: The proportion of people on COPD registers in Wales with a severity of breathlessness that would indicate suitability for referral for pulmonary rehabilitation have ever been referred to the service.

Data collection end: March 2015

34.5%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.2.8.4

Pulmonary rehabilitation programmes should include multicomponent, multidisciplinary interventions, which are tailored to the individual patient's needs. The rehabilitation process should incorporate a programme of physical training, disease education, nutritional, psychological and behavioural intervention. [2004]

What was measured: Proportion of pulmonary rehabilitation programmes that offer walking based aerobic training.

Data collection end: April 2015

94%

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: Proportion of pulmonary rehabilitation programmes that offer cycling based aerobic training.

Data collection end: April 2015

82%

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: Proportion of pulmonary rehabilitation programmes that offer resistance or strength training.

Data collection end: April 2015

99.6%

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: Proportion of pulmonary rehabilitation programmes that provide disease education.

Data collection end: April 2015

100%

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included walking aerobic training.

Data collection end: April 2015

95%

Number that met the criteria: 6004 / 6319

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included upper limb (aerobic or resistance) exercise.

Data collection end: April 2015

92%

Number that met the criteria: 5839 / 6319

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included resistance training.

Data collection end: April 2015

89%

Number that met the criteria: 5602 / 6319

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included cycle aerobic training.

Data collection end: April 2015

70%

Number that met the criteria: 4429 / 6319

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included interval training.

What was measured: COPD007: The percentage of patients with COPD who have had influenza immunisation in the preceding 1 August to 31 March.

Data collection end: March 2016

79.9%

Data collection end: March 2017

79.2%

Area covered:

National

Source:

Health and Social Care Information Centre. Quality and Outcomes Framework.

Recommendation: 1.2.14.2

Patients with COPD should be reviewed at least once per year, or more frequently if indicated, and the review should cover the issues listed in table 6.

What was measured: Proportion of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months.

What was measured: Proportion of patients with COPD and Medical Research Council dyspnoea grade ≥3 at any time in the preceding 12 months, with a record of oxygen saturation value within the preceding 12 months

What was measured: COPD004: The percentage of patients with COPD with a record of FEV1 in the preceding 12 months.

Data collection end: March 2016

72.1%

Data collection end: March 2017

72.4%

Area covered:

National

Source:

Health and Social Care Information Centre. Quality and Outcomes Framework.

What was measured: COPD005: The percentage of patients with COPD and Medical Research Council dyspnoea grade ≥3 at any time in the preceding 12 months, with a record of oxygen saturation value within the preceding 12 months.

Data collection end: March 2016

95%

Data collection end: March 2017

95.6%

Area covered:

National

Source:

Health and Social Care Information Centre. Quality and Outcomes Framework.

Recommendation: 1.2.14.4

When patients with very severe COPD are reviewed in primary care, they should be seen at least twice a year, and specific attention should be paid to the issues listed in table 6. [2004] [Table 6 includes 'smoking status and desire to quit'.]

What was measured: The proportion of people with COPD with a smoking status recorded within the last year.

Data collection end: March 2015

71.7%

Area covered:

Wales

Source:

Royal College of Physicians. National COPD Audit Programme: primary care

Recommendation: 1.3.11.1

Spirometry should be measured in all patients before discharge. [2004]

What was measured: Proportion of people admitted with an exacerbation of COPD who had a spirometry result available.

Data collection end: September 2017

39.7%

Number that met the criteria: 14410 / 36341

Area covered:

England and Wales

Source:

Royal College of Physicians. National COPD Audit Programme: secondary care